Treatment Strategies for Obstetric Puerperal Genital Hematomas: A Case Series.

BACKGROUND: Puerperal genital hematoma is an infrequent but potentially life-threatening complication of childbirth. There are three approaches to care: expectant management, surgical evacuation, or uterine artery embolization. CASES: This retrospective case series compares the clinical courses of three patients who developed puerperal genital hematoma and were managed differently. We report the length of time to complete resolution of the hematomas and the associated morbidities for each patient. CONCLUSION: All three management approaches of puerperal genital hematoma can be effective. Among our three patients, surgical intervention of the puerperal genital hematoma provided the most prompt and definitive management with resolution of all symptoms in 9 days, compared with 3 weeks for expectant management and 20 weeks for treatment with uterine artery embolization. Intervention should be individualized based on the patient's symptoms, stability, and desires with consideration of the hematoma size and location as well as available institutional resources.

Offspring gender rates in active duty fighter pilots and flight officers.

INTRODUCTION: It has been reported in small studies that fighter pilots have a higher likelihood of producing female offspring secondary to job-related exposures. No large-scale study has investigated this potential gender disparity. METHODS: This retrospective study utilized electronic medical record systems to identify men with flight-related occupations within the U.S. military from September 2012 to January 2018. The gender of offspring born to those men at least one year after entry into the flight community were compared to gender rates of children born to the U.S. general population during the same time period. RESULTS: 10,879 and 62,624 children born to fighter pilots and pilots of non-fighter type aircraft respectively were compared. The gender distribution of children born to both communities was similar to U.S. general population trends. CONCLUSIONS: This large-scale study provides social reassurances that the degree of risk imposed on our nation's air defense force does not influence the gender balance of the subsequent generation.

Second-Trimester Fetal Loss in a Patient With Hyperemesis Gravidarum Complicated by Refeeding Syndrome.

BACKGROUND: Refeeding syndrome is a rare constellation of electrolyte abnormalities after reintroduction of glucose during an adaptive state of starvation and malnutrition, resulting in fluid shifts, end-organ damage, and, potentially, death. We present a case of fetal death in a patient with hyperemesis gravidarum complicated by refeeding syndrome. CASE: A 32-year-old obese, multigravid patient was admitted at 16 weeks of gestation with hyperemesis gravidarum and laboratory abnormalities concerning for refeeding syndrome after consuming a sugar-rich beverage. She was admitted to the hospital for electrolyte and fluid repletion; however, on hospital day 2, fetal death was diagnosed. CONCLUSION: Refeeding syndrome is a potentially fatal complication of hyperemesis gravidarum. Caution should be taken when reintroducing glucose during prolonged states of malnutrition to prevent the development of refeeding syndrome.